Haematological emergencies

Question 1

Does neutropenic sepsis always present with febrile neutropenia?

Answer 1

No

Patient can have neutropenia without fever

Question 2

What are the 2 defining features of neutropenic sepsis?

Answer 2

Absolute neutrophil count is 0.5 x 10(9)/L or lower

Temperature greater than 38 degrees Celsius OR any symptoms/signs of sepsis

Question 3

What is the main reason why neutropenic sepsis is a life-threatening emergency?

Answer 3

Neutropenic patients already have weakened immune system and are more likely to contract bacterial infections which can become disseminated and fatal

Question 4

Give 4 haematological risk factors for neutropenic sepsis?

Answer 4

Recent chemotherapy (usually within 14 days): Biggest risk factor

Immunotherapy with cytotoxic drugs

Stem cell transplant patient

Bone marrow disorders

Question 5

What treatment pathway is used for neutropenic sepsis?

Answer 5

Sepsis 6 care bundle

Question 6

How does a patient with neutropenic sepsis start the sepsis 6 care bundle treatment?

Answer 6

Call 999 ambulance for emergency transfer to hospital, ideally within 1 hour of neutropenic sepsis recognition

Question 7

What is included in the sepsis 6 care bundle, to treat neutropenic sepsis?

Answer 7

3 diagnostic and 3 therapeutic steps delivered within 1 hour after initial recognition of sepsis

1. Oxygen administration
2. Two sets of blood cultures
3. Venous blood lactate
4. Fluid resuscitation
5. Appropriate antibiotics
6. Monitor observations

Question 8

How should oxygen be administered to treat neutropenic sepsis?

Answer 8

Give oxygen therapy to people with reduced oxygen saturation (below 92%) or with an increase in oxygen requirement over baseline, to maintain oxygen saturation above 94% unless contraindicated

Question 9

How are the two blood cultures taken from the patient, in neutropenic sepsis treatment?

Answer 9

Paired cultures from a peripheral/central line in situ and periphery

Question 10

What is the first line antibiotic for neutropenic sepsis and why?

Answer 10

Continuous IV piperacillin with tazobactam (tazocin)

Provides anti-pseudomonal cover

Question 11

What hormone drug can you administer to patients with neutropenic sepsis and why?

Answer 11

Recombinant G-CSF eg. Filgastrim

Can be used as treatment and prophylaxis to prevent neutropenia

Question 12

If a patient with neutropenic sepsis is allergic to penicillin, which antibiotic should be administered instead?

Answer 12

Second-line: IV Meropenem

Tazocin contains penicillin so cannot be used